Aug 2, 2009

A Critical Omission in Bill Moyers' Interview w/Former Cigna VP

Bill Moyers' interview with former Cigna VP, Wendell Potter, was timely, though I wish it hadn't taken 15 years for Potter to see the light. Or was it that he felt the heat? Nevertheless, in an industry of tight lips and stealth PR tactics, it's good to have at least one insider willing to jump ship and spill the beans.

There was a critical omission, however, one key factor on which Mr. Potter needs to shed light. If the American public is going to know the whole story of the insurance industry's strangle-hold of American health care, lobbying efforts notwithstanding, this factor has to be exposed and addressed.

It concerns the insurance industry’s control of nation’s private medical delivery system via their managed care agreements with doctors and hospitals. These lengthy, complicated, and often adversarial contracts signed by medical providers to become part of a PPO or HMO network are heavily slanted toward the financial interests of the insurance companies. The denials of coverage and over-turned medical decisions that outrage patients, consumer-advocates, and members of Congress are actually stipulated by contractual clauses in the provider agreements. Or, they’re permitted by contractual reference to vague utilization review protocols and case management programs that the insurance companies also control.

Mr. Potter talked about insurance company bureaucrats standing between the doctor and patient. But, he needs to also acknowledge that Cigna’s agreements with its network providers completely allow it. Managed care companies leverage huge membership numbers to get exactly what they want in their contracts from providers. Whether it’s lower reimbursements or more control, insurance companies hold hospitals and physician groups hostage by the threat of losing patient revenue if they don’t agree to contractual terms. Even in the face of insufficient reimbursement levels or other unreasonable contractual stipulations, providers invariably sign these agreements because they have no other choice.

If Mr. Potter wants to expose some real dirt, let him find and release a copy of an actual provider agreement Cigna has with a network doctor or hospital. I doubt he’ll be able to do it. Such agreements are “proprietary,” you know. But, if he can, everyone will see just how lopsided those agreements really are in favor of the insurance companies. And, how they’ve completely codified a medical delivery system in which insurance company bureaucrats really can legally call all the shots.

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